State of Delaware Medical Practices Act
    Title 24, Section 17, 1770A

Delaware Administrative Code, Title 24, Professional Regulation

1700 Board of Medical Practice

25.0 Physician's Assistant

25.1 Definitions:

25.1.1 Rules and Regulations governing Physician/Surgical Assistant (PA) practice in the State of Delaware. For information relative to the following categories refer to 24 Del.C. Ch. 17:

25.1.1.1 Definition of PAs

25.1.1.2 Criteria for Licensure

25.1.1.3 Licensure Fee

25.1.1.4 Supervision of PAs

25.1.1.5 Prohibited Practices

25.1.1.6 Discipline

25.1.1.7 Scope of Practice

25.1.2 Legend - For the purpose of these rules and regulations the term "legend" is defined as any drug containing the statement "Caution: Federal law prohibits dispensing without prescription" required by section 503(b)(4) of the Federal Food, Drug, and Cosmetic Act as part of the labeling of all prescription drugs (and only such drugs). A "legend" drug is thus a prescription drug, III.B.3 and 24 Del.C. §2502(o).

25.2 Biennial Renewal of License

25.2.1 Physicians Assistants must renew their license on a biennial basis by payment of appropriate fees as established by 24 Del.C. §1770A(c).

25.2.2 Completion of required renewal form, and submission of documentation of one hundred (100) hours of Continuing Medical Education (CME), forty (40) hours of which shall be of the Category I type as outlined within the AMA Physician's Recognition Award as adopted by the AAPA.

25.3 Prescriptive Authority

25.3.1 Prescriptive authority for the therapeutic drugs and treatments will include the following:

25.3.1.1 Prescriptive authority is a delegated medical service by the supervising physician.

25.3.1.2 Prescriptive authority will be practice specific of the supervising physician.

25.3.1.3 PAs may prescribe legend medication including Schedule II-V controlled substances, (as defined in the Controlled Substance Act). parenteral medications, medical therapeutics, devices and diagnostics.

An applicant who does not meet the usual educational requirements for licensure may apply through the "Fifth Pathway" if the following conditions are met:

26.1 The applicant has studied medicine at a medical school outside the United States or Canada which was approved by the government of the country where the medical school is located to confer a doctorate of medicine and surgery or its equivalent. The medical school must have been approved during the applicant's entire period of study. and be listed in the World Health Organization Directory;

26.2 The applicant has successfully completed all academic requirements of a matriculated student of that school for a diploma conferring a doctorate of medicine and surgery or its equivalent including any clinical rotations but who has not received the degree due to an additional requirement such as social service;

26.3 All clinical clerkship rotations served in the United States or Canada as part of training received in a medical college or school must be conducted in an institution that is a formal part (primary hospital) of a medical college or school or has a formal affiliation with a medical college or school approved by the appropriate accrediting body of the American Osteopathic Association or the American Medical Association or such clinical rotation must be served in a hospital which has. at the time the rotation is served, a residency training approved by the Accreditation Counsel for Graduate Medical Education in the area of the clinical rotation;

26.4 The applicant has successfully completed a one year program of supervised clinical training under the direction of a medical school approved by the Liaison Committee on Medical Education and has submitted a certificate attesting to the satisfactory completion of the program by the sponsoring medical school;

26.5 The applicant has completed the post graduate hospital training required by the Board of all applicants for licensure;

26.6 The applicant has passed the examination(s) required by the Board of all applicants for licensure.

§ 1770A. Physician's assistants (P.A.'s).

(a)  As used in this section:

(1) A "physician's assistant" is defined as an individual who has graduated from a physician's or surgeon's assistant program which has been accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association (AMA), or a successor agency acceptable to and approved by the Board, has passed a national certifying examination acceptable to the Physician's Assistant Advisory Council of the Board and approved by the full Board, and who is licensed under this chapter to practice as a physician's assistant. Physician's assistants who are currently registered in the State but who are not graduates of an approved program of the type outlined above may be licensed to practice as, and use the title "physician's assistant," provided the individual has successfully passed 1 of the national certifying examinations developed and administered by the National Board of Medical Examiners (NBME) or the National Commission on Certification of Physician's Assistants (NCCPA) on or prior to October 1987, and has maintained Continuing Medical Education (CME) credits as required by rules and regulations developed under this chapter.

(2) "Supervision of physician's assistants" means the ability of the supervising physician to provide or exercise control and direction over the services of physician's assistants. The constant physical presence of the supervising physician is not required, provided that the supervising physician is readily accessible by some form of electronic communication and that the supervising physician can be physically present within 30 minutes if necessary.

    a. Any physician who delegates medical responsibility to a physician's assistant is  responsible for that individual's medical activities and must provide adequate supervision. No function may be delegated to a physician's assistant who by statute or professional regulation is prohibited from performing that function.  The delegating physician cannot be involved in patient care in name only. A physician's assistant shall not maintain or manage an office separate and apart from the supervision physician. No regulation of the Board shall purport to authorize physician's assistants to engage in diagnosis, to prescribe or dispense legend drugs or therapeutics, to practice medicine or surgery or refractions or to pronounce a patient dead in any setting independent of the supervision of a physician who is licensed to practice medicine and surgery.  Such licensed physician's assistants shall  not delegate an assigned task to any other individual, nor shall they independently bill a patient for services rendered at the request of the physician.

    b. For the purpose of clarification, the terms "guidelines," "standing orders," "protocols" and "algorithms" are synonymous in their application under these regulations. Hereafter, the term "standing orders" will be used. Prescription and nonprescription medications may be initiated by standing orders if these standing orders have been approved by the responsible delegating physician and by the Physician's Assistant Regulatory Council.  Emergency care as defined in the Medical Practices Act is exempted from these regulations.

    c. It is appropriate and good medical procedure for all responsible physicians who choose to have their patients followed by physician's assistants to personally reevaluate at least every 3 months any patient receiving controlled substances or at least every 6 months any patient receiving other prescription medications or therapeutics.

    d. A supervising physician may not delegate responsibilities in assisting the physician to a physician's assistant that exceed the physician's specialty.

    e. A supervising physician who fails to adhere to these regulations would be considered to be permitting the unauthorized practice of medicine (as defined under § 1703(c) of this chapter (the Medical Practices Act)) and would be subject to disciplinary action by the Board of Medical Practice. A physician's assistant will at all times be under the control of  a licensed physician, as defined in this chapter.

(3) The phrase "delegated medical acts" means the performance of health care activities and duties by a physician's assistant under the delegation and control of a supervising physician.

(1) Adopt regulations regarding activities which may be undertaken by physician's assistants and shall license all certified physician's assistants with the Board.

(2) Define the scope of practice of physician's assistants including:

    a. Issuance of license to physician's assistant to allow:
        1. Performance of delegated medical acts within the education and experience of the physician's assistant; and
        2. Performance of services customary to the practice of the supervising physician(s);

    b. Delegated medical services provided by a physician's assistant to include but not limited
        to:
        1. Performance of complete histories and physical examinations;
        2. Recording of patient progress notes in an outpatient setting;
        3. Relaying, transcribing, or executing specific diagnostic or therapeutic orders so long as all such notes, orders and other writings shall be reviewed and countersigned by the supervising physician within 24 hours, barring extraordinary events or circumstances;
        4. Delegated acts of diagnosis and prescription of therapeutic drugs and treatments within the scope of physician's assistant practice defined within the Rules and Regulations promulgated by the Physician's Assistant Regulatory Council and approved by the Board of Medical Practice;
        5. Prescriptive authority for therapeutic drugs and treatments within the scope of physician's assistant practice defined within Rules and Regulations promulgated by the Physician's Assistant Regulatory Council and approved by the Board of Medical Practice. The physician's assistant's prescriptive authority and authority to make independent medical diagnoses and treatment decisions shall be subject to biennial renewal upon application to the Physician's Assistant Regulatory Council;

   c. Nothing in this chapter may be construed to authorize a physician's assistant to practice independent of a supervising physician;

    d. Except as otherwise provided in this chapter or in a medical emergency, a physician's assistant may not perform any medical act which has not been delegated by a supervising physician.

(3) Suspend or revoke the license of a physician's assistant or otherwise discipline a physician's assistant for engaging in unprofessional conduct as defined in § 1731(b) of this title or for inability to render medical services with reasonable skill or safety to patients because of mental illness or mental incompetence, physical illness or excessive use of drugs, including alcohol. Any disciplinary action undertaken against a physician's assistant shall be in accordance with those procedures applicable to disciplinary actions against physicians as set out in subchapter V of this chapter. An appeal of disciplinary action imposed by the Board shall be taken in accordance with subchapter V of this chapter.

(d)  Hospitals, clinics and other health care facilities may employ physician's assistants; however, no more than 2 physician's assistants may be employed and supervised for each physician practicing in the same facility. Physician's assistants employed by health care facilities must work under protocols approved by the Board.

(e)  A physician's assistant shall not practice as a member of any other health profession as authorized under this title unless the physician's assistant is duly authorized to practice that other profession under its respective chapter and title of this Code.

(f)  Notwithstanding any provision of this section to the contrary, the Board may grant a temporary license to an individual who has graduated from a physician's or surgeon's assistant program which has been accredited by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association (AMA) and who otherwise meets the qualifications for licensure but who has not sat for a national certifying examination; provided, that the individual shall sit for the next scheduled national certifying examination.  Any temporary license granted by the Board pursuant to this subsection shall be valid until the results of said examination are available from the certifying agency. In the event that the applicant fails to pass the national certifying examination, any temporary license granted by the Board pursuant to this subsection shall be immediately rescinded until such time as the applicant can successfully qualify for licensure as otherwise provided by this chapter.
 

(68 Del. Laws, c. 147, § 2; 68 Del. Laws, c. 345, § 1; 69 Del. Laws, c. 355, §§ 3-5; 71 Del. Laws, c. 102, § 26.)